Dizziness

What are the Signs and symptoms of Dizziness?
Characteristics of dizziness may include:

A sense that you or your surroundings are spinning or moving (vertigo)

A loss of balance

Nausea

Unsteadiness

Wooziness

Lightheadedness

Faintness

Weakness

Fatigue

Difficulty concentrating

Blurred vision following quick head movements

What are the causes of Dizziness? Potential causes may include:

Vertigo the false sense of motion or spinning – is the most common symptom of dizziness. Sitting up or moving around may make it worse. Sometimes vertigo is severe enough to cause nausea and vomiting. Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear (vestibular system), which sense movement and changes in your head position. Abnormal rhythmic eye movements (nystagmus) almost always accompany vertigo. Causes of vertigo may include:

Benign paroxysmal positional vertigo (BPPV). BPPV involves intense, brief episodes of dizziness associated with a change in the position of your head, often when you turn over in bed or sit up in the morning. It occurs when particles of calcium carbonate crystals (otoconia) break loose and fall into the wrong part of the canals in your inner ear. When these particles shift, they stimulate sensors in your ear, producing an episode of vertigo. Doctors don’t know what causes BPPV, but it may be a natural result of aging. Trauma to your head also may lead to BPPV.

Inflammation in the inner ear (acute vestibular neuronitis or labyrinthitis). Signs and symptoms of inflammation of the inner ear include sudden, intense vertigo that may persist for several days, with nausea and vomiting. It can be incapacitating, requiring bed rest to minimize the signs and symptoms. Fortunately, vestibular neuronitis generally subsides and clears up on its own. Although the cause of this condition is unknown, it may be a viral infection.

Meniere’s disease. This disease involves the excessive buildup of fluid in your inner ear. It may affect adults at any age and is characterized by sudden episodes of vertigo lasting 30 minutes to an hour or longer. Other symptoms include the feeling of fullness in your ear, buzzing or ringing in your ear (tinnitus), and fluctuating hearing loss. The cause of Meniere’s disease is unknown.

Vestibular migraine. The cause of vertigo may be a migraine. People who experience a vestibular migraine are very sensitive to motion. Dizziness and vertigo caused by a vestibular migraine may be triggered by turning your head quickly, being in a crowded or confusing place, driving or riding in a vehicle, or even watching movement on TV. A vestibular migraine also may cause feelings of imbalance or unsteadiness, hearing loss, “muffled” hearing, or ringing in your ears (tinnitus). For most people with a vestibular migraine, vertigo doesn’t happen at the same time as the headache. In fact, migraine-associated vertigo may occur without an actual migraine. Attacks of migrainous vertigo can last from a few minutes to several days.

Acoustic neuroma. An acoustic neuroma is a noncancerous (benign) growth on the acoustic nerve, which connects the inner ear to your brain. Symptoms of an acoustic neuroma may include dizziness, loss of balance, hearing loss and tinnitus.

Rapid changes in motion. Riding on a roller coaster or in boats, cars or even airplanes may on occasion make you dizzy.

Are there any complications associated with dizziness?

Dizziness can increase your risk of falling. Accidents while driving a car or operating heavy machinery are more likely. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated When is advisable to seek medical advice?

You should see your doctor if you experience any unexplained, recurrent or severe dizziness. Although it’s uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:

A new, different or severe headache

Blurred vision

Hearing loss

Speech impairment

Leg or arm weakness

Loss of consciousness

Falling or difficulty walking

Numbness or tingling

Chest pain or rapid or slow heart rate

These signs and symptoms may signal a more serious problem, such as stroke, brain tumor, Parkinson’s disease. Multiple sclerosis or cardiovascular disease. Your doctor will want to know what medications you’re taking. He or she will also ask you when you experience dizziness, how long it lasts and how often it occurs. Your doctor can narrow down possible causes of dizziness after determining the type of dizziness you’re experiencing, reviewing your medical history and current medications, conducting a physical examination, and ordering further testing based on your signs and symptoms. Doctors can usually determine the cause of dizziness. It may require a consultation with an ear, nose and throat (ENT) specialist or a neurologist. But even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.

Benign Paroxysmal Positional Vertigo (BPPV)

Patient Information

What are the causes for BPPV?

Research has shown that the most common cause of BPPV in individuals under age 50 is head injury and some associations with migraine. In older people, the most common cause is degeneration of the vestibular system of the inner ear. BPPV becomes much more common with advancing age (Froeling et al, 1991). In half of all cases, BPPV is called “idiopathic,” which means it occurs for no known reason. Viruses affecting the ear such as those causing vestibular neuritis, minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome and Meniere’s disease are significant but unusual causes. Occasionally BPPV follows surgery, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear (Atacan et al 2001). Other causes of positional symptoms are discussed here.

What is the treatment for BPPV?

The Epley maneuver is also called the particle repositioning, canalith repositioning procedure, and modified liberatory maneuver. It is illustrated in figure 2. It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

Home Treatment of BPPV

BRANDT-DAROFF EXERCISES

The Brandt-Daroff Exercises are a method of treating BPPV, usually used when the office treatment fails. They succeed in 95% of cases but are more arduous than the office treatments. These exercises are performed in three sets per day for two weeks. In each set, one performs the maneuver as shown five times. 1 repetition = maneuver done to each side in turn (takes 2 minutes)

Suggested Schedule for Brandt-Daroff exercises

TIME

EXERCISE

DURATION

Morning

5 repetitions

10 minutes

Noon

5 repetitions

10 minutes

Evening

5 repetitions

10 minutes

Start sitting upright (position 1). Then move into the side-lying position (position 2), with the head angled upward about halfway. An easy way to remember this is to imagine someone standing about 6 feet in front of you, and just keep looking at their head at all times. Stay in the side-lying position for 30 seconds, or until the dizziness subsides if this is longer, then go back to the sitting position (position 3). Stay there for 30 seconds, and then go to the opposite side (position 4) and follow the same routine.. These exercises should be performed for two weeks, three times per day, or for three weeks, twice per day. This adds up to 52 sets in total. In most persons, complete relief from symptoms is obtained after 30 sets, or about 10 days. In approximately 30 percent of patients, BPPV will recur within one year. If BPPV recurs, you may wish to add one 10-minute exercise to your daily routine (Amin et al, 1999).

INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont maneuvers)

Wait for 10 minutes after the maneuver is performed before going home. This is to avoid “quick spins,” or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don’t drive yourself home.

Sleep semi-recumbent for the next two nights. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure 3). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eyedrops are required, try to put them in without tilting the head back. Shampoo only under the shower.

For at least one week, avoid provoking head positions that might bring BPPV on again.

Use two pillows when you sleep.

Avoid sleeping on the “bad” side.

Don’t turn your head far up or far down.
Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist’s office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No “sit-ups” should be done for at least one week and no “crawl” swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. touching the toes). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley or Semont maneuver, unless specifically instructed otherwise by your health care provider.

At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can’t fall or hurt yourself. Let your doctor know how you did.